The objectives of this research is to evaluate targeted continuing educational programs (TCEP) and compare primary, modular and team nursing care structures using pre-test-post-test control group design. The TCEP and nursing care structures will be comparatively evaluated with respect to: 1. Cost of nursing care; 2. Quality of nursing care; 3. Satisfaction of patients, nursing staff and the medical staff; and, 4. Level of nurse utilization. The proposed research evaluates TCEP and nursing structures to separate the effects of people from the effects of structures. The primary hypothesis of this research is that the nurse competency has significantly higher effect on the cost/benefit of care than the structural arrangements. However, it is also hypothesized that there will be significant differences between primary, teams and modular nursing structures. Four models of primary structures are evaluated and it is hypothesized that there will be significant differences between various primary nursing care structures as well. The least expensive model of primary nursing may also be most effective because it attempts to maximize the registered nurse's time utilization in professional and direct care activities. Pre-test data will be collected on seven nursing units. Six of these units will be given targeted continuing education programs (TCEP) and one will be a control unit. This design will allow for the cost/benefit evaluation of TCEP. There are three pairs of nursing units practicing team, modular and primary nursing structures. One team and one modular unit will be converted to primary structures after the evaluation of TCEP. After changing to primary nursing structures, data will be collected to evaluate cost/benefit of various nursing care structures. The cost/benefit evaluation of TCEP and nursing structures can be compared to analyze the relative effectiveness of changing nurse competency or the nursing structure.